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Home My WebLink About7506-zFOB, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupency No. Date ........ THIS CERTIFIES that the building located at ....~h.~..~--,o~. ~. Street Map No ....~, ....... Block No .... X ...... Lot No../~ ...... eanforms substantially to the Application for Building Permit heretofore filed in this office dated .... · .C~,~. O~. ~...., 19.]. .'[ pursuant to which Building Permit No. dated ............ ~..<~....., 19.7.~/, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which · (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I--IOlJS~ lq'UMBER ..............8tx ......... ~7-. ~ ............................ FOlder NO. 9 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7506 Z Permission is hereby granted to: o...~rJ.m~,~lrA,....AZC.. ~.A..~.,l~m~laBki ........ at premises located at(~l~l~...~l~ .................................................................................................. Out, oho .IGC.... II:.~... pursuant to application dated .......................~i~g.....~6 ............... , 19~...., and approved by the Building Inspector. FOB~M NO. 1 TOWN OF ~OUTHOLD BU~ILDING DEPARTMENT TOWN CLERK'S OFFICE ~UTH~D, N. Y. .......... Application No. APPLICATION FOR BUILDING PERMIT__ ..~ '' Date ........... ~ ..~'.....~.. ............... , 19.?....~.,..~ INSTRUCTIONS ~0 a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wirier,: 3 sets of plans, accurate plot plan to scale. Fee according, to schedule. b. ,Plot plan ,~howing location of~ lot and of buildings on premises,, rpl~tionsbip to adj,oinif)g premises or public streets or areas, anc~ giving a detailed description of laYout of property must be drawn on diagra~ which iS p~rt of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ,shall be kept o the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have bce~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffo/k County, New York, and other applic~bTe Laws, Ordina~cee or R'e~ulati~ns, fcjr the COnstruction of building, additions or alterations, or for removal or demolition, as herein described. The app!icant .agrees to comply wit~ all applicable laws. ordinancel, building code, housing code, and regulations, and to admit authorized inspectors on premises 8n, d i~ bt~d~ ing~ for r~cessery inspections. (Signature ~f applicant, or~nallle ~0,q~'p~ion (Addr ,m~bf, ~licant) State whether applicant is owner, le. seee, agent, a_rch'~ct, engineer, general cot~traCtqr, electrician, plumbe~ or builder. Name of owner of premises ...... ..~... x... ~ ......................................... : .................. ! ................. If applicant is a corporate, signature of duly authorized officer. Builder,s License NO. ""- Plumber's License No. Electrician's License No. Other Trade's License No ....... ..'W, ........................................ 1. L~ation of land on which prop~ work will ~ done. Map No..../~~.~.~~~... Str.t and Num~r ...... ~...:~.~.~...;~ ......... 2. S". exi.ing u. and ~u.ncy of .remi.s and in.~,~; ~upancy of pm~ .n~ct~n: b. In~n~ um ~gd ~u~nev ....... 9. 13. 14. Nature of work (check which applicable): New Building ....................... Addition ...... ~ ......... Alteration ............... Repair ......... Removal .............. Demolition ........................ Other Work .................................... ........................... (Description) Estimated Cost ~ ~F?3J_ t 0-0 .. Fee ................... ~.~... .................................................................... ....... I" .................................. (to be paid on filing this application) If dwelling, number of dwelhng units ................. Number of dwelling units on each floor ......................................... If garage, number of cars ............................. If business, commercial or mixed occuoancy, specify nature and extent of. each type of use ......~ ........................... Dimensions of existing structures, if any: Front ..... .~..{3 ........ Rear ....... .~..~. ............. Depth ....~..~t ........................ He ght .........~ ................................ Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front ......~'~..,~ ........... Rear .....~,~.,.; ...................... Depth .......... 7..(~ .......................... Height ............ ..-==... ........................ Number of Stories ........... ~ ..................... Dimensions of entire new construction: Front ............. ~ ........ Rear ....~ ....................... Depth ................................. Height Number of Stories ..................................... Size of lot: Front ........... .~.. ........................ Rear .................... ..--. ............ w.... Dep.[.h ......... ~"~"...:4 ............................... Date of Purchase .....~3/:.....¢.-~..j. .......... Name For..,mer Ow~ner ...~,~¢w~t~..~ ............................ Zone or use dlstr,ct ~n which premises am s~tuated ...¢f.~.d~,~..~.....~-~....X~,e,,~e .................................................... Does proposed construction violate any zoning law, ordinance or regulation. .........J~:~..........-. ................................... Will lot be regreded ~.....'~;......~ ................. ~jll excess~ll be~remoyAd f, Eon~ premises.: [ ] Yes [ ] No .--- Name of O.er of pram,see PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines· Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. ,L._"~'~ °~'¢'0 f STATE OF NEW YORK, COUNTY OF ...................................................... ~ tlvame ~fid~idhal stg~ing con~act) He is the ................................................................................ ~...~......L ................................................................................................ (Contractor, a~nt, co~mte officer, etC:} , of said owner or owners, and is duly authorized to ~rform or have ~rformed the said work and to make and file this a~plication; that all statements contained in this application are true to t~ set forth in the application filed therewith. ................................ ,....,,,o, .................................................. Notary Public ...................................................................... ~unW ....... [.......~...~,,~: ................................... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, o certificate of Code compliance fram the Architect or Engineer responsible for the building. $. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buildings and "pre-existing" land uses: ]. Accurate survey of property showing oll property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent formation required to prepare o certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 o,e .... New Building ................ Addition ....~,~ ......... Old or Pre-ex/sting Building ................ Vacant Land .............. Of Property ..~...~....~;~...~.~...~....~..,....~....~..~.....;./A _ ......... Location Owner Or Owners Of Property ...A...~...~. ...... ~.'..~.~ ...................................................... Subdivision ................................................................ Lot No ............. Block No........--~..... House No.......~:z.. Permit No..~-~..,~..6 Dote Of Permit ..~/~,.~Applicont ~_~ 1~,.~,,~,4.z.~-~._~'. ........... Health Dept. Approval ......... ; .................................. Labor Dept. Approval ................................................ Underwriters Approval .......... ~ .............................. Planning Board Approval ......... '----. .............................. Request For Temporary Certificate '~- Final Certificate .....~,,.,'~..,,,...~.. ................... Fee Submitted $ .......<~. ...... ~ .............. Construction on above described building andj~.errr~i,t mee~ts all aEglicable codes and regulations. Sworn to before me this/% ....... · .~,.~,~. day of ..... ~ .~......oTTo.,... -~.f...~.. ~ c,~ Notary Public ............. (stamp or